脊柱侧凸手术中TES-MEP、CSEP阳性与手术操作相关原因分析  

Relevant factors between operative procedure and positive findings of TES-MEP and CSEP monitoring during the scoliotic surgery

作　　者：陈裕光[1] 万勇[1] 郑召民[1] 杨军林[1] 彭新生[1] 邹学农[1] 夏杰华[2] 舒海华[2] 李佛保[1] 

机构地区：[1]中山大学附属第一医院脊柱外科,广东510080 [2]中山大学附属第一医院麻醉科

出　　处：《脊柱外科杂志》2010年第2期86-89,共4页Journal of Spinal Surgery

摘　　要：目的探讨脊柱侧凸手术中经颅电刺激运动诱发电位(transcranial electrical stimulation motorevoked poten-tial,TES-MEP)和/或皮层体感诱发电位(cortical somatosensory evoked potential,CSEP)阳性与手术操作相关因素。方法 2006年7月～2009年4月,本科行脊柱侧凸手术151例,术中同时监测双侧胫前肌、足拇短屈肌TES-MEP以及双侧胫后肌CSEP。根据术中诱发电位的阳性变化详细检查和分析是否与手术操作不当有关。结果 TES-MEP成功检出率为96.7%,CSEP成功检出率为96%。术中诱发电位阳性27次,除5次不明原因外,22次与手术操作不当相关。其中15次及时采取纠正措施,13次恢复正常,2次明显恢复;7次仅经药物干预和观察处理者,其中6次不能完全恢复,1次无恢复。结论椎弓根钻孔或螺钉置入、内固定器械矫形、截骨过程和截骨面靠拢等手术操作是导致诱发电位阳性的主要原因。Objective To investigate the relationship between the operative procedure and positive findings of TES-MEP and CSEP during the scoliotic surgery. Methods From July 2006 to April 2009,151 systemic patients were simultaneously monitored for the TES-MEP responses on bilateral anterior tibial muscle and flexor hallucis brevis and the CSEP response on bilateral posterior tibial muscle. According to the positive findings of TES-MEP and CSEP,the inappropriate operative maneuver was recorded for the analysis. Results TES-MEP and CSEP recordings were 96.7% and 96%,respectively. In this series,27 positive in 25 cases occurred,excepted for 5 times with an unknown cause,the other 22 times were associated with the inappropriate operative maneuver. By correction of operative maneuver,13 times were back to normal and 2 times close to normal in 15 times; however,6 times were not able to normal and 1 time was no recovery by the use of pharmaceutical intervention and observation in 7 times. Conclusion The relevant factors of the positive TES-MEP and/or CSEP during the scoliotic surgery are closely associated with the operative maneuver including pedicle drilling or pedicle screws placement,the correction of deformity with the interval fixation,drawing close the two side of vertebral osteotomy during the process of vertebral osteotomy.

关 键 词：脊柱侧凸 诱发电位 运动 诱发电位 躯体感觉 电刺激 手术中并发症 

分 类 号：R682.3[医药卫生—骨科学]